Abstract

ABSTRACT Aim This study aimed to compare the prognostic performance of the risk models for patients with hepatocellular carcinoma (HCC) receiving atezolizumab and bevacizumab (Atez/Bev) as first‐line treatment. Methods Among 449 patients included in this retrospective multicenter study, we compared the prognostic performance of 13 risk models for the 12‐month and 18‐month survival status using area under the curve (AUC), net reclassification improvement (NRI), and relative integrated discrimination improvement (IDI) analysis. We also constructed a calibration plot to assess the fitness of each model. Results Regarding the analysis of the 12‐month survival status, none of the risk models demonstrated AUC values higher than the modified albumin‐bilirubin (mALBI) grade. In the NRI analysis, only the IMmunotherapy with AFP, BCLC staging, mALBI, and DCP evaluation (IMABALI‐De score) exhibited a statistically significant improvement compared with the mALBI grade ( p = 0.009). While the modified albumin‐bilirubin grade (mALF) score and prognostic nutritional index (PNI) did not exhibit significant differences compared to the mALBI grade ( p = 0.3 and 0.2, respectively), the remaining risk models were inferior to the mALBI grade. In the relative IDI analysis, none of the risk models showed a significant improvement compared with the mALBI grade. The calibration plot of the PNI was unsatisfactory. The results for the 18‐month survival status were consistent with those for the 12‐month survival status. A time‐dependent ROC analysis demonstrated that both the mALBI grade and the mALBI‐based model showed consistent performance over time. Conclusions The mALBI grade, as well as the IMABALI‐De and mALF scores (both of which are risk models based on mALBI grade), exhibited reliable performance in predicting the prognosis of patients with HCC.